ClenchAlert Return Form

1

Name on the purchase* This field is required.Information will be available in the order invoice email that is received.

First Name

Last Name

2

Email used to make the purchase* This field is required.Information will be available in the order invoice email that is received.

example@example.com

3

What is your order number?* This field is required.The order number is on your purchase invoice, which was emailed to you.

numbers only

4

Date of Purchase* This field is required.Please enter the date of your purchase

Date

5

Reason for the return* This field is required.Select one or more reasons for the return

The product didn’t fit comfortably

I didn’t notice the results I expected

The alerts or feedback weren’t working as expected

The product didn’t integrate well with my routine or sleep

I experienced sensitivity or irritation

The product arrived damaged or defective

Other

6

You selected "other" as the reason. Please share few words about your experience.

7

Help us improve our product* This field is required.We are always striving to provide the best experience for our customers. Would you like to participate in a quick 3-question survey?

Yes

No

8

Can you describe your experience using ClenchAlert?Please provide a detailed description of your experience with ClenchAlert. What worked well, what could be improved.

9

How was your experience interacting with our website?Please provide some information about your experience interacting with our website, your shopping experience, or our customer experience. Any improvements we can make? Any questions we can answer to better assist your shopping experience in the future?

10

When did you primarily use ClenchAlert?

During the day

During sleep

Both

11

Return Request Submission

Date

Hour

Minutes